Post-transplant infection improves outcome of hepatocellular carcinoma patients after orthotopic liver transplantation
Post-transplant infection improves outcome of hepatocellular carcinoma patients after orthotopic liver transplantation
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移植后感染改善原位肝移植后肝细胞癌患者的预后
DOI：
10.3748/wjg.v25.i37.5630
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发表时间：
2019-10-07
影响因子：
4.3
通讯作者：
Sun, Hong-Cheng
中科院分区：
文献类型：
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作者：
Chao, Jia-Shuo;Zhao, Sen-Lin;Sun, Hong-Cheng
背景原位肝移植（OLT）后的肿瘤复发仍然对肝细胞癌（HCC）受体的长期生存构成严重威胁，因为很少有因素或措施显示出对克服OLT后HCC复发的影响。术后感染可能通过刺激免疫系统来抑制肿瘤复发并提高肺癌和恶性神经胶质瘤患者的生存率。移植后感染（PTI）是一种常见的并发症，从短期角度来看被认为对肝移植受者有害。尽管如此，PTI是否能抑制OLT后HCC复发并延长HCC患者的长期生存期仍需阐明。目的探讨PTI对原发性肝细胞癌(HCC)患者OLT后生存及肿瘤复发的潜在影响。方法回顾性纳入2002年8月至2016年7月期间在我中心接受OLT的238例HCC患者，并据此分为PTI组（53例）和非PTI组（185例）。采用Kaplan-Meier法进行单因素分析，包括PTI亚组与非PTI亚组之间总生存期（OS）、无复发生存期（RFS）和复发后生存期（PRS）的差异以及生存曲线分析，并采用对数秩检验比较差异。使用 Cox 比例风险模型将单变量分析中 P 值 < 0.1 的变量纳入多变量生存分析。结果 全组1、3、5年OS率和RFS率分别为86.6%、69.0%和63.6%，75.7%、60.0%和57.3%。 PTI患者组的1年、3年和5年OS率（96.0%、89.3%和74.0%）显着高于非PTI组（84.0%、63.4%和60.2%）（P = 0.033）。缺乏 PTI 是 OS 不佳（相对风险 [RR] = 2.584，95%CI：1.226-5.449）和 RFS 不利（RR = 2.683，95%CI：1.335-5.390）的独立危险因素。亚组分析显示，PTI 显着改善有血管侵犯 (IV) 的 HCC 患者的 OS (P = 0.003) 和 RFS (P = 0.003) 率，但对无血管侵犯 (IV) 的患者的 OS (P = 0.404) 和 RFS (P = 0.304) 没有影响。在移植后肿瘤复发的患者中，有 PTI 的患者的 OS (P = 0.026) 和 PRS (P = 0.042) 率明显优于无 PTI 的患者。结论 PTI 改善了移植后死亡和肿瘤复发高风险的移植 HCC 患者的 OS 和 RFS，这归因于 PTI 对 HCC 复发的抑制作用。
BACKGROUND Tumor recurrence after orthotopic liver transplantation (OLT) remains a serious threat for long-term survival of the recipients with hepatocellular carcinoma (HCC), since very few factors or measures have shown impact on overcoming HCC recurrence after OLT. Postoperative infection suppresses tumor recurrence and improves patient survival in lung cancer and malignant glioma probably via stimulating the immune system. Post-transplant infection (PTI), a common complication, is deemed to be harmful for the liver transplant recipients from a short-term perspective. Nevertheless, whether PTI inhibits HCC recurrence after OLT and prolongs the long-term survival of HCC patients needs to be clarified. AIM To investigate the potential influence of PTI on the survival and tumor recurrence of patients with HCC after OLT. METHODS A total of 238 patients with HCC who underwent OLT between August 2002 and July 2016 at our center were retrospectively included and accordingly subdivided into a PTI group (53 patients) and a non-PTI group (185 patients). Univariate analyses, including the differences of overall survival (OS), recurrence-free survival (RFS), and post-recurrence survival (PRS), between the PTI and non-PTI subgroups as well as survival curve analysis were performed by the Kaplan-Meier method, and the differences were compared using the log rank test. The variables with a P-value < 0.1 in univariate analyses were included in the multivariate survival analysis by using a Cox proportional-hazards model. RESULTS The 1-, 3-, and 5-year OS and RFS rates of the whole cohort were 86.6%, 69.0%, and 63.6%, and 75.7%, 60.0%, and 57.3%, respectively. The 1-, 3-, and 5-year OS rates for the PTI patient group (96.0%, 89.3%, and 74.0%) were significantly higher than those for the non-PTI group (84.0%, 63.4%, and 60.2%) (P = 0.033). The absence of PTI was an independent risk factor for dismal OS (relative risk [RR] = 2.584, 95%CI: 1.226-5.449) and unfavorable RFS (RR = 2.683, 95%CI: 1.335-5.390). Subgroup analyses revealed that PTI remarkably improved OS (P = 0.003) and RFS (P = 0.003) rates of HCC patients with vascular invasion (IV), but did not impact on OS (P = 0.404) and RFS (P = 0.304) of patients without VI. Among the patients who suffered post-transplant tumor recurrence, patients with PTI showed significantly better OS (P = 0.026) and PRS (P = 0.042) rates than those without PTI. CONCLUSION PTI improves OS and RFS of the transplant HCC patients at a high risk for post-transplant death and tumor recurrence, which is attributed to suppressive effect of PTI on HCC recurrence.